26: 2 K- 7

LE GISLA TlVE HISTO RY CHE CKLiST

NJSA: 26: 2 K-7 to 26: 2 K-20 (Mobile intensive care units-authorize certain advanced life support ser­vices)

LAWS OF: 1984 CHAPTER: 146

Bill No: A551

Sponsor(s): Her man and Pankok

Date Introduced: Pre-filed

Com mittee: Asse mbJy: Corrections, Health and Hu man Services

Senate: Institutions, Health and Welfare

Amended during passage: Yes Substituted for S989 (not attached since identical to A551). Amend ments during passage denoted by asterisks

Date of Passage: Asse mbly: April 30, 1984

Senate: July 30, 1984 r'

Date of Approval: Sept. 8, 1984

Following statements are attached if available: \~., .. Ii" _ ..

Sponsor state ment: Yes

Com mittee state ment: Assembly Yes

Senate" Yes

Fiscal Note: No

No

Message on Signing:

Following were printed:

Reports: No

Hearings: No

.\,'

C)\/ i

'.,

/'16

[OFFICIAL COPY REPRINT]

ASSEMBLY, No. 551

STATE OF NEW JERSEY

PRE-FILED FOR INTRODUCTION IN THE 1984 SESSION

By Assemblymen HERMAN and P ANKOK

AN ACT concerning emergency medical serVICes, supplementing

Title 26 of the Revised Statutes, and repealing P. L. 1973, c. 229.

1 BE IT ENACTED by the Senate and General Assembly of the State

2 of New Jersey:

1 1. As used in this act:

2 a."Advanced life support" means an advanced level of pre­

3 hospital, inter-hospital, and emergency service care which includes

4 basic life support functions, cardiac monitoring, cardiac defibrilla­

5 tion, telemetered electrocardiography, administration of anti ­

6 arrhythmic agents, intravenous therapy, administration of specific

7 medications, drugs and solutions, use of adjunctive ventilation

8 devices, trauma care and other techniques and procedures autho­

9 rized in writing by the commissioner;

10 ""[b. "Basic life support" means a basic level of pre-hospital care

11 which includes patient stabilization, airway clearance, cardio­

12 pulmonary resuscitation, hemorrhage control, initial wound care

13 and fracture stabilization and other techniques and procedures

14 authorized by the commissioner ir 15 *[c.]"" ""b."" "Board ""of Medical Examiners*" means the State

15A Board of Medical Examiners;

15B ""c. "Board of Nursing" means the New Jersey Board of Nurs­

15c ingi""

16 d·.· "Commissioner" means the Commissioner of the ·State·

17 Department of Health;

18 e. "Department" means the State Department of Health·[.]· .;""

19 f. "Emergency service" means a program in a hospital staffed, EXPLANATIO~-Matter'enclosed in bold-laced brackets [thus] in the Jiliove bill

ill not enacted and is intended to he, otniuea in the law., ,.' , , . Matter printed In italics thus is new matter. . '

. ltttttet' -eficlosed iii. '~terisks'oi 'Ita~' hii~ b~~n ad'oi>i&l ar loIioWil ,*_Aa8embl1.conunittee,ameudmeutl ",c1opted ~eh~.l~~ 19~.~. .

'-.,

2

20 24 hours a day by a licensed physician trained in emergency

21 medicine;

22 g. "Inter-hospital care" means those emergency medical services

23 rendered by mobile intensive care units to emergency patients

24 before and during transportation between emergency *[rooms]""

25 ·treatment facilities'll, and upon arrival within those facilities;

26 *[h. "Mobile intensive care nurse" means a registered professional

27 nurse trained in advanced life support services and approved by the

28 commissioner to render those services as part of a mobile intensive

29 care unit;]·

30 *[j.]. *h.* "Mobile intensive care paramedic" means a person

31 trained in advanced life support services and certified by the com­

32 missioner to render advanced life support services as part of a

33 mobile intensive care unit;

34 *[j. "Emergency medical technician" means a person trained in

35 basic life support services and certified by the commissioner ;].

36' .[k.]. 'IIi. * ."Mobile intensive care unit" means a specialized eme~­

37 gency medical service vehicle staffed by ·[mobile intensive' care

38 nurses and]* mobile intensive care paramedics ·or registered pro­

39 fessional nurses trained in advanced life support nursing'll arid

40 operated for the provision of advanced life support services under

41 the direction of an authorized hospital;

42 *[1.]* .j.* "Pre-hospital care" means those emergency "medical

43 services rendered by mobile intensive care units to emergency

44 patients before and during transportation to emergency *[rooms]*

45 ·treatment facilities·, and upon arrival within those facilities.

1 *[2. a. A registered professional nurse shall obtain the commis­

2 sioner's approval to staff a mobile intensive care unit alid shall

3 make application therefor on forms devised by the commissioner.

4 b. The commissioner shall establish written standards which a

5, registered professional nurse shall meet in order to obtain his

6 approval.

7 c. The commissioner shall maintain a register of all applications

8 for approval hereunder, which register shall include but not be

9 'limited to:

10 (1) The name and residence of the applicant j

11 (2) The date of the application;

12 (3) Whether the applicant was rejected or approval was grante~

13 and the date' of tliat action. The commissioner shall annually

14 compile a list of mobile intensive care nurses. This list shall be

15 available.to the public.]· .'

1 *[3.]* ·2.· a. A ~mobile intensive..carl3* .pal~ame<iic shaH obtain

2 certification from the corifuiissiorrer tostaff..tnnobil~·-'intensive Care

,) "

..3 ...unit..andshall make application therefor on forms prescrIbed b}­

3A.. the commissioner.

4. b. The commissioner"[,]* with the approval of the board"[,]*

·5· "of medical exam,iners* shall establish written standards which a

.6. *mobile intensive care* paramedic shall meet in order to obtain

7 certification. The commissioner shall act"[,]# on a regular

8 basisot.[,]* upon applications of candidates for certification as *a*

9 mobile intensive care *[paramedics]* *paramedic*. The commis­

10 sioner shall certify a candidate who provides satisfactory evidence

n of the successful completion of an educational program approved

12 by the commissioner for the training of mobile intensive care para­

13 medics and who passes *[a department administered]* *an* ex­

14 amination in the provision of advanced life support services, which

14A examination shall be conducted by the department at least twice

14B *[each] * "a* year.

15 c. The department shall maintain a register of all applicants for

16 certification hereunder, which register shall include but not be

17 limited to:

18 (1) The name and residence of the applicant;

19 . (2) The date of the application;

20 (3) Information as to whether the applicant was rejected or

21 certified and the date of that action.

22 The department shall annually compile a list of mobile intensive

23. care paramedics. This list shall be available to the public.

1 *[4. a. An emergency medical technician shall obtain certification

2 from the commissioner to provide basic life support services and

3 shall make application therefor on form prescribed by the commis­

4. sioner.

5. -b. The commis'sioner shall establish written standards which an

6 . emergency medical technician shall meet in order to 0 btairl certifica­

7 tion. The commissioner shall certify a candidate who provides

8 satisfactory evidence of the successful completion of an educational

9 program approved by the commissioner for the training of emer­

10 gency medical technicians and who passes a department adminis­

11 tered examination in the provision of basic life support services,

12 which examination shall be conducted by the department at least

13 twice each year.

14 c. The department shall maintain a register of all applicants for

15 ..certification hereunder, which register shall include but not be

16 limited to:

17 (1) The name .an.d r~si~enc~ of the applicant; .

18...... .G2) :r1;Le. ·dat.e .of the, ~pp1ica~io.~ ; ~~-'."--' ,:". . .. - . ,. .

19 (3) ,WheiheJ; th~ ~pplicant wafS reje~ted.or ce.r.tified 9£ that action. ;.. . .."" . - ..... .... ,-.... ." "- . ... .' . .. '.

4

20 The departnient shall annually compile a list of emergency

21 medical technicians. The list shall be available to the public.] ­

1 ·[5.]· oilS.· The commissioner after notice and hearing may re­

2 voke the *'[approval of a mobile intensive care nurse, or the]­

3 certification of a mobile intensive care paramedic "'[or emergency

4 medical technician]'*' for violation of any provision of this act 01'

5 regulation ·[adopted]· ·prom~dgated· hereunder.

1 ·[6.]· *4.· A ·[mobile intensive care nurse and]· mobile in­

2 tensive care paramedic may perform advanced life support services,

3 provided they maintain direct voice communication with and are

4 taking orders from a licensed physician or physician directed

5 ·L1icensed]· ·registered professional· nurse, both of whom are

6 affiliated with a mobile intensive care hospital which is approved

7 by the commissioner to provide advanced life support services. A

8 telemetered electrocardiogram shall be monitored when deemed ap­

9 propriate by the licensed physician ·[or physician directed licensed

10 nurse]· or when required by written rules and regulations

11 • [adopted]* «<established'*' by the mobile intensive care hospital

12 and approved by the c.ommissioner.

1 *[7.]* «<5.* If the direct voice communications fail, a mobile in­

2 tensive care paramedic *[or mobile intensive care nurse]· may

3 perform any advanced life support procedure ·101' which that per­

4 son is certified and which is included in a written protocol estab­

5 lished by the mobile intens'ive care hospital and· approved by the

6 commissioner if, in the judgment of the nurse or paramedic, the

7 life of the patient is in immediate danger and requires that care

8 for his preservation.

1 *[8.]* *6.'" a. Only a hospital authorized by the commissioner

2 with an accredited emergency service may develop and maintain

3 a mobile intensive care unit, and provide advanced life support

4 services utilizing licensed physicians, "'[mobile intensive care]'"

5 ·registered professional'" nurses ·trained in advanced life support

5A nursing*, and mobile intensive care paramedics.

6 h. A hospital authorized by the commissioner pursuant to sub­

7 section a. of this section shall provide mobile intensive care unit

8 services on a continuous 24 hour-a-day, 7 day-a-week ba·sis.

9 c. The commissioner shall establish, in writing, criteria which a

10 hospital shall meet in order to qualify for the authorization.

11 d. The commissioner may withdraw his authorization if the

12 hospital or unit violates any provision of this act or rule or regula­

13 tion !t[adopted]'" ·promulgated· pursuant thereto.

1 *[9.]· "'7.· a. No person may adv~rtlse or disseminate informa·

2 tion to the pUbli~ that the person provides' ad~aileed life support

5

'3 services by a mobile intensive care unituriless the person is au­

4 'thorized to do so pursuant to section iM<[8]· "'6'" of this 'act.

5 b. No person may impersonate or refer to himself as a mobile

6 intensive care paramedic "'[or mobile intensive care nurse or emer­

7 gency medical technician]'" unless he is certified or approved-there­

8 for, as appropriate.

1 "'[10.]'" "'8.'" No ""[mobile intensive care nurse,]'" mobile intensive

2 care paramedic, "'[emergency medical technician]· licensedphy­

3 sician,. "'[physician directed licensed nurse,]'" hospital-or its board

4 of trustees, officers and members of the medical staff·, 'nurses

5 ·[and]'" *'01'''' other employees of the hospital"', first aid, amb1.tlance

6 or rescue squad, or o/fice?'s and members of a r'esctte sq1.wd, *' shall

7 be liable for any civil damages as the result of an act or the' omis­

8 sion of an act committed while in *[the]'" training for or in the

9 rendering of *[basic or]*' advanced life support services in good

10 faith and in accordance with this act.

1 ''[11.]* "'9.· An individual who violates the provisions of this

2 act"'[, or obstructs or interferes with any duly authorized agent in

3 the performance of his duty under this act]· is'subjecttoa penalt)'

4 of $200.00 for the first offense and $500.00 for eiwh subsequent

5 offense. "'[A hospital that violates the pr~visions -or" this act is

6 subject to a penalty of $1,000.00 for the first offense and $2,500.00

7 for each subsequent offense.]* If the violation of this act is"of a

8 continuing nature, each day during which it continues shall con­

9 stitute a separate offense for the purposes of this section. The

10 penalty shall be collected and enforced by summary proceedings. . 11 under "the penalty enforcement law," (N. J. S. 2A :5S:-1etseq.).

1 *[12, Nothing in this act shali be interpreted to permHa'mobile

2 intensive care paramedic to perform the duties or fill th~'po'sition ~f

3 a health care professional employed by the hospital, except that the

4 paramedic may perform those functions that are necess~ry'to as~ur~

5 the orderly transfer of advanced life support care from the mobile

6 intensive care unit to hospital staff upon arrival at an emergency

7 room, and that are necessary to obtain the clinical training in the

8 provision of advanced life support services required by the depart­

9 ment.]'"

1 "'10. The commissioner shall establish a State mobile intensive

2 care advisory council which shall advise the depa?'tment on all

3 matters of mobile intensive care services. The council shall select

4 a chairman annually to chair the meetings and coordinate the activi­

5 ties of the advisory council. The chairman shall appoint subcom­

6 mittees to review and recommend policy on subjects incl1.tding, b1.tt

7 not limited to, advanced life support training programs, advanced

(;

8 life support patient care equipment, biomedical and telecommuni­

9 cations equipment and procedures, and treatment protocols as well

10 as other medical matters.·

1 ·[13.]· ·11.· The commissioner shall *[adopt]* *promulgate*

2 such rules and regulations in accordance with the "Administrative

3 Procedure Act," P. L. 1968, c. 410 (C. 52:14B-1 et seq.) • as he

4 deems necessary to effectuate the purposes of this act,· and the

5 board ·of medical examiners and the board of n1.lKsing· shall

6 ·[adopt]· ·promulgate such· rules and regulations as ·[it deems]*

7 ·they deem· necessary to carry out ·[its]· ·their· functions under

8 this act.

1 ·12. Nothing in this act shall be interpreted to permit a mobile

2 intensive care paramedic to perform the duties or fill the position

3 af another health care professional employed by the hospital, except

4 that the paramedic may perform those functions that are necessary

5 to assure the orderly transfer of advanced life support care from

6 the mobile intensive care unit to hospital staff upon arrival at an

7 emergency room, and that are necessary to obtain the clinical train­

8 ing in the provision of advanced life support services req'ttired by

9 the department.

1 13. Nothing in this act shall be construed as interfering with an

2 emergency service training program authorized and operated under

3 provisions of the ((New Jersey Highway Safety Act of 1971," P. L.

4 1971, c. 351 (0. 27:5F-1 et seq.).

1 14. Nothing in this act shall be construed to prevent a licensed

2 and qualified member of the health care profession from performing

3 any of the duties of a mobile intensive care paramedic if the duties

4 are consistent with the accepted standards of the mem..ber's pro­

5 fession.·

1 ·[14.]· ·15.· P. L. 1973, c. ·[299]· ·.229· (C. 26 :2K-1 et seq.)

2 is repealed.

1 ·[15.]· ·16.· This act shall take effect 90 days following enact­

Z ment.

5

4 members of the medical staff, nurses and other employees of the

5 hospital shall be liable for any civil damages as the result of an act

6 or the omission of an act committed while in the training for or in

7 the rendering of basic or advanced life support services in good faith

8 and in accordance with this act.

1 11. An individual who violates the provisions of this act, or

2 obstructs or interferes with any duly authorized agent in the per­

3 formance of his duty under this act is subject to a penalty of

4 $200.00 for the first offense and $500.00 for each subsequent offense.

5 A hospital that violates the provisions of this act is subject to a

6 penalty of $1,000.00 for the first offense and $2,500.00 for each sub­

7 Isequent offense. If the violation of this act is of a continuing nature,

8 each day during which it continues shall constitute a separate

9 offense for the purposes of this section. The penalty 'shall be

10 collected and enforced by summary proceedings under "the penalty

11 enforcement law," (N. J. S. 2A:58-1 et seq.).

1 12. Nothing in this act shall be interpreted to permit a mobile

2 intensive care paramedic to perform the duties or fill the position of

3 a health care professional employed by the hospital, except that the

4 paramedic may perform those functions that are necessary to assure

5 the orderly transfer of advanced life support care from the mobile

6 intensive care unit to hospital staff upon arrival at an emergency

7 room, and that are necessary to obtain the clinical training in the

8 provision of advanced life support services required by the depart­

9 ment.

1 13. The commissioner shall adopt such rules and regulations in

2 accordance with the "Administrative Procedure Act," P. L. 1968, c.

3 410 (C. 52:14B-l et seq.) and the board shall adopt rules and regu­

4 lations as it deems necessary to carry out its functions under this

5 act.

1 14. P. L. 1973, c. 299 (C. 26:2K-l et seq.) is repealed.

1 15. This act shall take effect 90 days following enactment.

STATEMENT

The purpose of this bill is to broaden those situations in which

mobile intensive care personnel may act, yet simultaneously regu­

lating their qualifications so as to insure the quality of the emer­

gency service rendered.

Under existing law, P. L. 1973, c. 229 (C. 26 :2K-l et seq.), mobile

intensive care paramedics may perform certain medical services,

provided they maintain direct voice communication with a physician

and a telemetered electrocardiogram is monitored. Immunity from

6

civil liability is provided for ac:tsrenderad under those learcum­

stances. This bill repeals P. L. 1973, c. 229 CC.26:2K-l et seq.).

This bill allows mobile intensive care nur.ses and mobile intffilsiv:e

care paramedics to perform advanced life support services au­

thorized by the commissioner, where direct v.oiee .communication is

maintained with a licensed physician or physicimJ. directed licensed

nnrse; provision is made for the administration of advanced life

support services in the event of a communication failure. This bill

also provides penalties for falsely advertising and disseminating

information to the public regarding the provision of mobile in­

tensive care services, or falsely representing oneself as a mobile

intensive care nurse or paramedic. Immunity from liability is

extended to cover the training of mobile intensive care paramedics

and all individuals and organizations in the program.

ASSEMBLY' CORRECTIONS; 'HEAiTH' AND HUMAN SERVICES .COMMITTEE

STATEMENT TO

ASSEMBL Y, No. 551 with Assembly committee amendments

STATE OF NEW JERSEY

DATED: MARCH 15,1984

This bill allows registered nurses with special training and mobile

intensive care paramedics to perform advanced life support services

authorized by the Commissioner of Health when they maintain direct

voice communication with a licensed physician or physician directed

registered nurse, or, in the event that direct voice communications fail,

if the patient is in immediate danger of losing his life and requires this

care in order to survive.

The bill repeals P. L. 1973, c. 229 (C. 26:2K-l et seq.), the existing

law governing mobile intensive care, and broadens those situations in

which mobile intensive care personnel may deliver medical services.

The bill also extends the immunity from civil liability for persons acting

in good faith under the existing law to cover the training of mobile

intensive care paramedics and all persons and organizations in the

program.

The bill provides penalties for any individual who falsely advertises

or disseminates information to the public concerning the provision of

mobile intensive care services or falsely represents himself as a spe­

cially trained registered nurse or paramedic.

The bill also provides that a mobile intensive care paramedic shall

not be permitted to perform the duties of a health care professional

employed by a hospital except as is necessary to assume the orderly

transfer of advanced life support care from a mobile intensive care

unit to hospital staff upon arrival at an emergency room, and also to

obtain the clinical training in providing advanced life support services

required of mobile intensive care paramedics by the Department of

Health.

The committee adopted amendments that would exempt nurses from

having to obtain the Commissioner of Health's approval to staff a

mobile intensive care unit.

The amendments also provide for the establishment of a State mobile

intensive care advisory council to advise the Department of Health on

mobile intensive care matters.

2

In addition, the amendments retain a provision in the existing law

specifying that legislation authorizing the use of mobile intensive care

units does not apply to any emergency training service program oper­

ated pursuant to the" New J~rsey Highway Safety Act of 1971."

... ... :: ' ....,. . .: ...~ ~

SENATE INSTITUTIONS, HEALTH AND WELFARE COMMITTEE

STATEMENT TO

ASSEMBLY, No. 551 [OFFICIAL COpy REPRINT]

STATE OF NEW JERSEY

DATED: .JUNE 18, 1984

This bill allows registered professional nurses with training in

advanced life support nursing and mobile intensive care paramedics to

perform advanced life support services authorized hy the Commissioner

of Health when they maintain direct voice communication with a licensed

physician or physician directed registered nurse, or, in the event that

direct voice communications fail, if the patient is in immediate danger

of losing his life and requires this care in order to survive.

The bill repeals P. L. 1973, c. 229 (C. 26 :2K-1 et seq.), the

existing law governing mobile intensive care, and broadens those

situations in which mobile intensive care personnel may deliver medical

services. Under the provisions of the bill mobile intensive care para­

medics shall be certified by the Department of Health and pass an exam­

ination on the provision of advanced life support services. Also, para­

medics, first aid and rescue squad members, nurses, physicians alld other

hospital personnel are granted immunity from civil liahility for any

acts or omissions committed in good faith, while in trainillg for or in

the rendering of advanced life support services.

This bill also provides that a mobile intensive care paramedic is not

permitted to perform the duties of a health care professional employed

by a hospital except as is necessary (a) to assume the orderly transfer

of advanced life support care from a mobile iniensive care unit to

hospital staff upon arrival at an emergency room, and (b) to obtain

the clinical training in providing advanced life support services re­

quired of mobile intensive care paramedics by the Department of

Health.

Finally, the bill establishes a State mobile intensive care advisory

council to advise the Department of Health on mobile intensive care

matters.

Presently, paramedic programs have been approved by the Depart­

ment of Health to cover 85910 of the citizens of the State. The paramedics

work from mobile intensive care units (MICU's) which are based in

hospitals. Local rescue and first aid squads work with the lVIICU's and

render basic life support procedures to persons until the paramedic

arrives to provide advanced life support procedures such as cardiac

difibrillation, telemetered electrocardiogaphy and administration of

certain medications and drugs.

lol

·OFFICE OF THE GOVERNOR NEWS RELEASE

TRENTON, N.J. 08625 CARL GOLDEN Release: M(II., SEPT., 10, 1984 609-292-8956

Governor Thomas H. . Kean today signed legislation to permit

municipalities to create tt special improvement districts" to promote economic

growth and employment in downtown business districts.

The legislation, 5-1680, was sponsored by Senator John Lynch,

D-Middlesex.

The bill permits municipalities to create special improvement districts in

downtown areas and to levy a special assessment on all property within that

district. The funds raised from the assessment would be used by

newly-designated district management corporations to develop and implement

self-help programs to enhance local business district climates.

The legislation extends the currently-held authority of municipalities to

create pedestrian malls. as a local business improvement project. The

creation of special improvement districts would be an additional method of

revitalizing older downtown shopping districts.

The Governor also signed legislation to permit mobile intensive care

nurses and paramedics to perform advanced life support duties, provided

that direct voice communication is and maintained wit~.: a ,l ,

physician or licensed nurse. P9Gt~RT( 'y

NEW J£JSEy :T,4 ;-~_;~-'-\I

- more ­

185 W. State St'eet Trenton, ('oJ, J.

..

·1 ~ ~..::,.r,'~~~;l»",J.':'';P';'':''~''';>;;;'''''.~'~'~

8-1680 ET AL. SIGNED

PAGE TWO

SEPTEMBER 10, 1984

The legislaton, A-551 , was sponsored by Assemblyman Martin Herman,

D-Gloucester, and empowers the Commissioner of the Department of Health to

develop standards which would have to be met before an individual would be

certified to perform the advanced life support function.

The bill becomes effective in 90 days.

Other bills signed by the Governor are:

A-785 , sponsored by Assemblyman Alan Karcher, D-Middlesex, to make

consistent the disability retirement benefits of the State Police Retirement

and Benevolent Fund and its predecessor, the State Police Retirement

System.

A-1295, sponsored by Assemblyman Karl Weidel, R-Mercer, to

appropriate $1.5 million for the repair and renovation of the Trenton War

Memorial Building.

A-2114, sponsored by Assemblyman Robert Littell, R-Sussex, to exempt

the leasing of certain telephone equipment from the bidding requirements of

the local public contracts law.

A-21, sponsored by Assemblyman Jimmy Zangari, D-Essex, to provide

that the mounted height of headlights shall be not more than 54 inches nor

less than 24 inches, bringing the State into conformance with Federal

standards.

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